GS29P�EFFECT OF IMMUNE-ENHANCED SUPPLEMENTED FORMULAS IN PERIOPERATIVE OUTCOMES: A META-ANALYSIS

Purpose: Providing enteral supplements containing ‘immunonutrition’ has been proposed to decrease postoperative complications and duration of hospital stay for elective surgical patients. This meta-analysis was undertaken to elucidate the potential benefit of providing immune-enhanced nutrition in surgical patients. Methodology: A search of Medline, Embase, Science Citation Index, PubMed and the Cochrane Database identified all RCTs comparing the use of perioperative immunonutrition with standard nutrition provision in elective adult surgical patients between 1990 and 2008. The variables analysed included mortality, total complications, infective complications, anastomotic leak and length of hospital stay. Results: 21 distinct studies were identified that met inclusion criteria involving 2135 patients (immunonutrition n = 1100; standard nutrition n = 935). The provision of immunonutrition was shown to be associated with significant reductions in the incidence of total postoperative complications (OR 0.50, 95% CI 0.37, 0.69, p < 0.0001), postoperative infective complications (OR 0.47, 95% CI 0.37, 0.60, p < 0.0001), anastomotic breakdown (OR 0.43, 95% 0.25, 0.75, p = 0.003), and the duration of hospital stay (WMD −2.95, 95% CI −4.01, −1.88, p < 0.0001) when compared to standard nutritional provision. No differences were seen between interventions with relation to mortality (OR 0.90, 95% CI 0.41, 1.97. p = 0.8). Conclusion: Provision of immunonutrition in preference to standard nutrition was associated with clinically significant decreased length of hospital stay, reduction in the development of postoperative complications including those of infective origin and anastomotic breakdown but has no impact on mortality.